ACUTE CORONARY

SYNDROME
• Definition
OUTLINE
• Types of ACS
• Epidemiology/Risk factors
• Pathophysiology
• Signs and symptoms
• Management
• Prevention
• Complications
• Conclusion
 INTRODUCTION
Acute coronary syndrome (ACS) is the umbrella term for the clinical signs
and symptoms of myocardial Ischemia: unstable angina, non-ST-segment
elevation myocardial infarction (Non-STEMI), and ST-segment elevation
myocardial infarction (STEMI).

Acute coronary syndrome (ACS) is a set of signs and symptoms due to

decreased blood flow in the coronary arteries such that part of the
heart muscle is unable to function properly or dies
 RISK FACTORS
Non-modifiable Risk factors include

•age,
•Male sex, family history, and
•ethnicity or race (caucasians)
•Men have a higher risk than women.
•Men older than age 45, women older than age 55,
•anyone with a first-degree male or female relative who developed
coronary artery disease before age 55 or 65, respectively, are also
at increased risk.
Modifiable risk factors include
•elevated levels of serum cholesterol,
• low-density lipoprotein cholesterol, and triglycerides; lower
levels of high-density lipoprotein
•cholesterol; and the presence of type 2 diabetes,
• cigarette smoking,
•obesity, a sedentary lifestyle
• hypertension
•stress
 PATHOPHYSIOLOGY
•Usually, blood flow is decreased because of blockage within one or more of the
coronary arteries supplying the heart muscle (coronary artery disease).
This blockage is typically the result of a buildup of fatty deposits (plaque) that
gradually block the flow of blood and oxygen in the artery (atherosclerosis)
•Atherosclerotic narrowing of the coronary artery is the most frequent source of
cardiac ischemia and angina; however, endothelial damage or dysfunction in the
heart, a sudden tightening or narrowing of the coronary artery (vasospasm), or severe
narrowing of the aortic valve (aortic stenosis) may also interfere with coronary blood
flow, reduce delivery of oxygen to heart tissue, and cause angina.
• Angina can also be caused by other mechanisms that reduce oxygen delivery, such
as anemia (low red blood cell count and/or low hemoglobin), low blood pressure
(hypotension), bradycardia, exposure to carbon monoxide, and inflammation.
 SIGNS AND SYMPTOMS
• The cardinal symptom of critically decreased blood flow to the heart is Chest pain, experienced as tightness
around or over the chest and (often, but not always) radiating to the left arm and the left angle of the jaw.
• diaphoresis (sweating), nausea and vomiting, as well as shortness of breath.
• In many cases, the sensation is "atypical", with pain experienced in different ways or even being completely
absent (which is more likely in female patients and those with diabetes). Some may report palpitations, anxiety or
a sense of impending doom (angor animi) and a feeling of being acutely ill.
• Though ACS is usually associated with coronary thrombosis, it can also be associated with cocaine use.
• Chest pain with features characteristic of cardiac origin (angina) can also be precipitated by profound anemia,
brady- or tachycardia, low or high blood pressure, severe aortic valve stenosis, pulmonary artery hypertension
and a number of other conditions.
 UNSTABLE ANGINA
Cause
• Thrombus partially or intermittently occludes the coronary artery
Signs and Symptoms
• Pain with or without radiation to arm, neck, back, or epigastric region
• SOB, diaphoresis, nausea, lightheadedness, tachycardia, tachypnea, hypotension or hypertension, decreased arterial
oxygen saturation (Sa02) rhythm abnormalities ; Occurs at rest or with exertion; limits activity

Diagnostic Findings:
ST-segment depression or T-wave inversion on electrocardiography (ECG); Cardiac biomarkers not elevated.

•Treatment (MONA-BAH)
• Oxygen to maintain oxygen saturation level at > 90%
• Nitroglycerin or morphine to control pain
• b-blockers, ACE inhibitors, statins (started on admission and continued long term), clopidogrel, unfractionated heparin
 Non-ST-Segment Elevation Myocardial Infarction (NSTEMI)
Cause: Thrombus partially or intermittently occludes the coronary artery
Signs and Symptoms:
•Pain with or without radiation to arm, neck, back, or epigastric region, SOB, diaphoresis, nausea, lightheadedness,
tachycardia, tachypnea, hypotension or HTN, Jed arterial oxygen saturation (Sa02) and rhythm abnormalities.
• Occurs at rest or with exertion: limits activity; Longer in duration and more severe than in unstable angina

Diagnostic Findings:
ST-segment depression or T-wave inversion on electrocardiography; Cardiac biomarkers are elevated
Treatment (MONA-BAH, PCD:
• Oxygen to maintain Sa02 level at > 90%
• Nitroglycerin or morphine to control pain
• b-blockers, ACE, statins (started on admission and continued long term clopidogrel, unfractionated heparin or LMWH, and
glycoprotein Ilb/Illa inhibitors
• Cardiac catheterization and possible PCI for patients with ongoing chest pain, hemodynamic instability, or increased risk of
worsening clinical condition
 ST SEGMENT ELEVATION MYOCARDIAL INFARCTION
(STEMI)
Cause:
Thrombus fully occludes the coronary artery

Signs and Symptoms:

Pain with or without radiation to arm, neck, back, orepigastric region, SOB, diaphoresis, nausea, lightheadedness,
tachycardia, tachypnea, hypotension or hypertension, decreased arterial 02 saturation (Sa02), and rhythm
abnormalities; Occurs at rest or with exertion;limits activity, Longer in duration and more severe than in unstable
angina (irreversible tissue damage [infarction] occurs if perfusion is not restored)

Diagnostic Findings: ST-segment elevation or new left bundle branch block on ECG. Cardiac biomarkers are
elevated

Treatment: (TPA, MONA-BAH, PCI): Fibrinolytic therapy within 30 minutes of medical evaluation, Oxygen to
maintain Sa02 level at > 90%
• Nitroglycerin or Morphine to control pain
• BB, ACEL, statins (started on admission & continued long term) clopidogrel,
 PREVENTION

• Acute coronary syndrome often reflects a degree of damage to the coronaries by

atherosclerosis.
• Primary prevention of atherosclerosis is controlling the risk factors: healthy eating,
exercise, treatment for hypertension and diabetes, avoiding smoking and controlling
cholesterol levels; in patients with significant risk factors, aspirin has been shown to
reduce the risk of cardiovascular events.

• After a ban on smoking in all enclosed public places was introduced in Scotland in
March 2006, there was a 17% reduction in hospital admissions for acute coronary
syndrome. 67% of the decrease occurred in non-smokers.
 COMPLICATIONS
• Arrythmia- the most common cause due to ischemia
• Congestive heart failure
• Pulmonary edema
• Cardiogenic shock
• Pericarditis
CONCLUSION